Physicians suspect that Santa Claus is able to make his annual around-the-world gift-giving journey because he is vigilant about getting yearly influenza vaccinations, having regular checkups and staying physically active, according to a statement issued by the Pennsylvania Medical Society last month.

"Santa never misses an appearance or a delivery, and that makes me think he gets an annual flu shot. He knows how dangerous it would be for him to spread influenza to the children, elves or Mrs. Claus, and how disappointing it would be for him to come down with the virus," said William Lander, MD, a family physician in Bryn Mawr, Pa. and past president of the organization.

The society issued this statement during the holiday season to point out what could be learned about Santa's longevity that may be applicable to patients.

"What we tried to do with this was take something relevant to the time in the calendar as an opportunity to educate patients about what they should be considering for their health," said Daniel Glunk, MD, an internist in Williamsport, Pa. and president-elect of the medical society.

According to the statement, the man in red most likely takes precautions against skin damage by using gloves, lip balm and sunscreen. His fitness routine probably includes flexibility and balance exercises to allow him to shimmy down chimneys and walk along rooftops, although physicians do worry that the extra weight around his middle will eventually be to his detriment.

"Getting him into an obesity program would probably help Santa's longevity, and I have hope that he and Mrs. Claus will get their weight down in the next year or two," Dr. Lander said.

Physicians elsewhere concur with much of the statement, and many suspect Santa maintains his overall health by staying in an occupation he loves. He stays mentally agile by making lists of who is naughty and nice. Time spent with animals such as reindeer also could keep him going.

"Certainly, the Grinch has a very short life expectancy because he does not have a positive mental attitude," said James Applegate, MD, a family physician in Grand Rapids, Mich. "And caring for animals has been shown to improve your longevity."

Although the lead health concern for Santa seems to be his girth, some also worry about the potential harm he faces from occupational hazards.

"My first concern is whether he could be developing the metabolic syndrome because of his truncal obesity, but he's had a good long life. He might be one of these people who are fit and fat," Dr. Applegate said. "But I wonder whether he might have lung disease like emphysema or COPD.I would want to check his lung function to make sure that coal dust and coming down chimneys is not a problem for him."

Serious holiday health concerns

Contemplating Santa's health and well-being is a lighthearted way to discuss with patients the importance of preventive care. But the holiday season also tends to bring with it some very serious developments that can have a grave impact -- on both people and the health care system. Specifically, this time is marked by increases in heart attack deaths.

"In many ways, the holidays constitute 'the perfect storm' for heart attacks, and emergency departments typically experience an influx of cardiac patients," said Linda Lawrence, MD, president of the American College of Emergency Physicians.

The circumstance has been documented by several studies. Notably, a paper in the Dec. 21/28, 2004, Circulation highlighted the occurrence of spikes around Christmas and also New Year's Day. The article estimated that 42,039 deaths from 1973 to 2001 could be attributed to the holiday season. The magnitude of the effect also increased from year to year.

"Hospitals need to be aware that there's an increase, and need to be adequately staffed," said Robert A. Kloner, MD, PhD, director of research at the Heart Institute of Good Samaritan Hospital in Los Angeles. He has authored several papers on this subject, including an editorial accompanying the Circulation study. "Physicians need to be aware of the phenomenon so they can advise their patients."

The exact cause of what are being called "Merry Christmas coronaries" and "Happy New Year heart attacks" is unknown; colder temperatures do not appear to explain them. Experts suspect they are caused by a combination of overindulgence and waiting until the holiday season is over to get medical attention. Regular medications may be forgotten. Emotions can run high. Patients tend to drink more alcohol, eat more and exercise less, but the holidays also might require them to be more physically active in ways that are not good for them.